Thread by @chitguppi

SARS-COV-2 is a weak virus inactivated by many disinfectants/ mouthwashes. Challenge is not 'virus inactivation'. That's easy. Challenge is how long will salivary viral loads remain low after mouth rinsing. It needs a long acting mouthwash with persistent action #COVID19 (1/n)

.To minimize #COVID19 spread that happens by coughing, talking etc you need to keep the salivary viral loads low for sufficient time. Only those mouthwashes with strong intraoral attachment mechanisms & persistent action in saliva can do it. This property is "SUBSTANTIVITY" (2/n)

.Not all mouthwashes have substantivity. A mouthwash may easily kill #SARSCoV2 when tested outside the mouth. But most critical question is whether it will have any long acting effect "inside the mouth". Mouthwashes with no substantivity will not be able to do so. #COVID19 (3/n)

. Overwhelming evidence has proven that only Chlorhexidine mouthwash has substantivity. Only Chlorhexidine has strong attachment mechanisms inside the mouth with sustained release in saliva. This persistent action is not seen with Povidone Iodine (betadine) or H2O2 #COVID19 (4/n)

. Early Chlorhexidine (CHX) studies
1. Used very low concentrations of CHX (0.01- 0.02% w/v)
2. Tested CHX against viruses other than SARS-COV-2

This gave an erroneous impression that CHX may not inactivate SARS-COV-2. However this notion was only till Mar 2020. #COVID19 (5/n)

. In April 2020, Hong Kong University published a study in The Lancet Microbe which showed that Chlorhexidine inactivated #SARSCoV2 in conc as low as 0.05% w/v.

Read the full story of all earlier evidence including the Lancet study here. #COVID19 (6/n)
researchgate.net/publication/34…

. May 2020: Korean study (clinical study in patients as a mouthwash) showed that Chlorhexidine reduced #SARSCOV2 viral load in saliva for 2 hrs. #substantivity This low viral load phase is important in preventing #COVID19 spread in clinic & community (7/n)
ncbi.nlm.nih.gov/pmc/articles/P…

My paper "Mouth Rinses with Substantivity Can Prevent COVID-19 Spread and Protect the Healthcare Workers"

Review of all studies including the classification of mouthwashes based on substantivity. (8/n)

#SARSCoV2 #Chlorhexidine #PovidoneIodine

Link:
papers.ssrn.com/sol3/papers.cf…

. My paper "Mouth Rinses with Substantivity Can Prevent COVID-19 Spread and Protect the Healthcare Workers"

My article is one of the most downloaded papers (9/n)

#SARSCoV2 #Chlorhexidine #PovidoneIodine

Link:
papers.ssrn.com/sol3/papers.cf…

Evidence - based approach for optimum infection control in OT during COVID-19 (Dexter et al Jul 2020)

1. Alcohol hand rubs.
2. Wipes with Quarternary Ammonium Compounds & Alcohol for equipment surfaces.
3. Preprocedural Chlorhexidine mouth rinses. (10/n)
journals.lww.com/anesthesia-ana…

. However, the recommendation to use Chlorhexidine mouthwash doesn't remove or substitute any existing standard preventive protocol: Physical distancing, well fitting masks, well fitting eyewear. Chlorhexidine mouthwash is an additional recommendation: 4th layer. #COVID19 (11/n)

. How to use Chlorhexidine mouthwash?
Rule: 10-20-30.
Take 10 ml volume
of 0.20% w/v concentration
rinse for 30 sec at least.
Preferably undiluted, in one shot.
Healthcare workers can give Chlorhexidine mouthwash to all patients before they enter the clinic.
#covid19 (12/n)

. We are not giving Chlorhexidine mouthwash to cure Covid-19 patients. It's given so that viral loads reduce in patients' saliva & SARS-COV-2 spread is minimized. This is to protect doctors & other healthcare workers who come in contact with asymptomatics & presymptomatics (13/n)